Healthcare Provider Details

I. General information

NPI: 1679981682
Provider Name (Legal Business Name): MALINDA GIBBONS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 S MISSION RD STE A
FALLBROOK CA
92028-4119
US

IV. Provider business mailing address

731 W ELDER ST UNIT B
FALLBROOK CA
92028-2815
US

V. Phone/Fax

Practice location:
  • Phone: 619-244-8998
  • Fax:
Mailing address:
  • Phone: 619-244-8998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: